TY - JOUR
T1 - A repeat audit of computed tomography scanning prior to fibreoptic bronchoscopy in the diagnosis of lung cancer
JF - European Respiratory Journal
JO - Eur Respir J
VL - 38
IS - Suppl 55
AU - Seymour, John
AU - Ho, Timothy
Y1 - 2011/09/01
UR - http://erj.ersjournals.com/content/38/Suppl_55/p4434.abstract
N2 - Background: United Kingdom (UK) clinical guidance recommends CT (computed tomography) imaging prior to conventional fibreoptic bronchoscopy (FOB) in the investigation of lung cancer. Previous audit at our centre reported that cancer was unlikely to be visualised in 67% of non-diagnostic FOBs based on the CT scan.Aims: We hypothesized that local practice would be consistent with UK guidance. A repeat audit was conducted to see whether the rate of CT scanning prior to FOB had improved.Methods: Patients with a final diagnosis of small cell (SCLC) or non-small cell (NSCLC) lung cancer over a 6-month period in 2010 and the equivalent period in 2008 were analysed. The timing of the CT scan and whether FOB resulted in a diagnosis from biopsy or cytology was recorded. CT scans were reviewed to assess whether a lesion was likely to be visible at FOB.Results: 88 patients (mean (SD) age 69 (11) years) with SCLC (n=13) and NSCLC (n=75) were identified in 2010. All underwent a CT scan. 32% of patients underwent FOB (60% in 2008). CT scanning was performed prior to bronchoscopy in 86% of patients (68% in 2008). Non-diagnostic FOBs remained common (48% in 2010, 35% in 2008). CT scans indicating endobronchial disease were associated with a positive likelihood ratio of 2.6 (2.8 in 2008). 62% of non-diagnostic procedures were predictable from the CT scan (67% in 2008).Conclusions: Despite earlier findings, a CT scan was not performed prior to FOB in all patients. Fewer FOBs occurred in 2010, and may be due to the selection of patients for endobronchial ultrasound. Non-diagnostic FOBs occurred in both periods, however, further reductions in unnecessary procedures may be achievable.
ER -